The disease begins with changes in the articular cartilage, due to which the articular surfaces of the bones slide.Malnutrition and loss of elasticity lead to its degeneration and resorption, and the bone tissue of the joint surfaces is loosened, gliding is broken, the joint space narrows, and the biomechanics of the joint changes.The synovial membrane that covers the joint and produces synovial fluid (which nourishes the cartilage and acts as a physiological lubricant) is irritated, causing an increase in its amount in the joint (synovitis).Against the background of narrowing of the joint space, the volume of the joint decreases, synovial fluid comes out on the back wall of the joint capsule, and Becker's cyst is formed (which, when it reaches a large size, can cause pain in the popliteal fossa).
The thin and delicate tissue of the joint capsule is replaced by rough connective tissue and the shape of the joint changes.Periarticular bone tissue grows, osteophytes (pathological bone formations) are formed.Blood circulation is disturbed in periarticular tissues, insufficiently oxidized metabolic products, irritating chemoreceptors accumulate in them, and constant pain syndrome develops.Against the background of changes in the anatomy of the joint, the functioning of the surrounding muscles is disturbed, hypotrophy and spasm appear, and walking is disturbed.Permanent limitation of range of motion (contracture) occurs in the joint, sometimes so pronounced that only rock movements (stiffness) or complete lack of motion (ankylosis) are possible.
Gonarthrosis is a fairly common disease: it affects 10% of the entire population of the planet, and every third person over 60 years old.
Causes of gonarthrosis
- Bone and joint injuries.
- Inflammatory joint diseases (rheumatoid, gout).
- Disorders of mineral metabolism in various endocrinopathies (diabetes, diseases of parathyroid glands, hemochromatosis).
- Diseases of the musculoskeletal system and neuropathy (Charcot's disease).
In addition to the main causes, there are also unfavorable background factors for the development of gonarthrosis, which include:
- Excess weight (literally puts pressure on the lower limbs);
- age (mainly older people get the disease);
- female gender (statistically, women get sick more often);
- Sports and professional physical activity increased.
Symptoms of osteoarthritis of the knee joints
- Pain that increases with walking and decreases with rest.
- Difficulty in normal, physiological movements in the joints.
- Characteristic "cramp" in the joints.
- An increase in the size of the joints and their visible deformation.
Stages of gonarthrosis
Clinical stages of knee joint arthrosis.The disease goes through several stages.
- At the first stage, a person feels only a slight discomfort or "heaviness" in the knee, which is disturbing when walking long distances or increasing physical activity.X-ray examination will be uninformative: only a slight narrowing of the joint space can be detected, there will be no other changes.At the onset of the disease, a person does not refer to specialists, does not attach much importance to the symptoms.
- The second stage is characterized by noticeable pain, the severity of which decreases with rest.There is difficulty in movement in the joints and a characteristic "creaking" is heard when walking (the patient may hear a common phrase in everyday life: "knees creaking").X-ray reveals clearly visible narrowing of the joint space and isolated osteophytes.
- When gonarthrosis moves to the next, third stage, the patient suffers pain constantly, including during rest, and there is a violation of the configuration of the joints, i.e. deformation, which is aggravated by swelling during inflammation.Radiographs show moderate joint space narrowing and numerous osteophytes.In the third stage, many people seek medical help because... the quality of life is significantly affected by pain and normal walking.
- The fourth stage is accompanied by constant, debilitating pain.The slightest attempt to move becomes a difficult experience for a person, the deformation of the joints is visually noticeable, and walking is extremely difficult.X-ray shows significant changes: the joint space is practically not defined in the images, many rough osteophytes, "joint mice" (deteriorated fragments of bone falling into the joint cavity) are revealed.This stage of gonarthrosis almost always causes disability: often the result of the disease is the complete fusion of the joint, its instability and the formation of a "false joint".
Who treats knee arthrosis?
A therapist, rheumatologist and general practitioner (family doctor) can provide qualified medical care for gonarthrosis, but these specialists treat the knee joint with uncomplicated arthrosis.When synovitis appears or the treatment prescribed by the therapist does not give the desired effect, then you cannot do without the help of an orthopedist.In situations where surgical treatment is required, the patient is sent to a specialized orthopedic and traumatological department.
How and with what to treat arthrosis of the knee joint?
The currently known methods of treating arthrosis of the knee joint are divided into non-medical conservative, medical and surgical methods.
Non-narcotic methods
Many patients ask the question: "How to cure arthrosis of the knee joint without pills?"Answering this question, we regret to note that gonarthrosis is a chronic disease and cannot be eliminated forever.However, many currently available non-pharmacological methods of combating this disease can significantly slow its progression and improve the patient's quality of life, especially when used in the early stages of the disease.If you refer to the doctor on time and the patient is motivated enough to heal, sometimes it is enough to eliminate negative factors.For example, it has been proven that losing excess weight reduces the manifestation of the main symptoms of the disease.
Eliminating pathological physical activity and, on the contrary, doing therapeutic exercises using rational physical programs reduces the intensity of pain.Exercises to improve quadriceps strength have been shown to have similar effects to anti-inflammatory medications.
If we treat arthrosis of the knee joint, then we should strive for proper nutrition: products containing a large amount of animal collagen and chondroitin (shrimp, crab, krill), fresh vegetables and fruits rich in plant collagen and antioxidants will help improve the elastic properties of articular cartilage.On the contrary, it increases metabolic disorders in the body and accumulation of excess weight to obesity.
When you think about what is the most effective treatment for knee arthrosis, we should remember such an effective treatment and preventive method as orthotics: fixing knee pads, orthoses, elastic bandages and orthopedic insoles reduces and correctly distributes the load on the joint, thereby reducing the intensity of pain in it.
Comprehensive treatment of arthrosis of the knee joint also involves the appointment of very effective physical procedures even in advanced forms of the disease.When widely used in various categories of patients with this disease, magnetic therapy has proven its effectiveness: after just a few procedures, pain intensity decreases, blood circulation improves, swelling and muscle spasm are eliminated, joint mobility increases.The effect of magnetic therapy is especially pronounced during the development of active inflammation in the joint: the severity of swelling decreases significantly, and the symptoms of synovitis regress.Not so popular, but no less effective for the treatment of arthrosis of the knee joint, such methods of physical therapy as laser therapy and cryotherapy (cold exposure), which have a pronounced pain-relieving effect.
Drug treatment
Nonsteroidal anti-inflammatory drugs (NSAIDs) that are available externally (various gels,ointments) and for systemic use (tablets, suppositories, solutions), have long proven their effectiveness in the treatment of osteoarthritis and are widely prescribed by doctors.By blocking inflammation at the enzymatic level, they eliminate joint pain and swelling and slow the progression of the disease.For the early manifestations of the disease, local use of these drugs together with non-medical methods is effective.But with advanced osteoarthritis of the knee joints, you cannot do without pills.It should be remembered that the long-term systemic use of non-steroidal anti-inflammatory drugs can lead to the development and exacerbation of ulcerative processes in the gastrointestinal tract, in addition to negatively affecting the functioning of the kidneys and liver.Therefore, patients who take non-steroidal anti-inflammatory drugs for a long time should also be prescribed drugs that protect the gastric mucosa and regularly monitor the laboratory indicators of the functioning of internal organs.
In advanced, "advanced" osteoarthritis, when a person has excruciating pain that does not go away with rest, disturbs normal sleep, and does not respond to the use of nonsteroidal anti-inflammatory drugs, corticosteroids, and non-drug methods, opioid pain relievers may be prescribed.These drugs are used only under the prescription of a doctor, who takes into account the appropriateness of their appointment in each specific case.
Chondroprotectors (literally translated as "cartilage protectors").This name refers to various drugs, united by one property - the effect of changing the structure, that is, the ability to slow down degenerative changes in cartilage and narrow the joint space.They are produced both for oral administration (glucosamine, chondroitin sulfate, piascledin) and for injection into the joint cavity (hyaluronates).Of course, these drugs do not work miracles and do not "grow" new cartilage, but they can stop its destruction.To achieve a long-lasting effect, they should be used for a long time, in regular courses several times a year.
Surgical treatment of arthrosis of knee joints
There are frequent cases when, despite adequate comprehensive treatment, the disease progresses, which steadily reduces the quality of a person's life.In such situations, the patient begins to ask questions: "What to do if prescribed medications do not help knee arthrosis?", "Is surgical treatment indicated for knee arthrosis?", "How is knee arthrosis treated surgically? When answering these questions, we must clarify that the indication for surgical treatment of knee osteoarthritis is a syndrome of endless pain and significant joint dysfunction that cannot be eliminated by complexusing conservative therapy.
The most popular type of surgical treatment of gonarthrosis is endoprosthesis, that is, removal of one's own joint with immediate installation of a replacement metal prosthesis, the design of which is similar to the anatomy of the human knee joint.At the same time, the prerequisite for conducting this type of surgical treatment is the absence of gross deformations of the joint, formed "false joints", muscle contractures and pronounced muscle atrophy.
In case of severe osteoporosis (significant decrease in bone mineral density), endoprosthesis is also not indicated: the "sugar" bone cannot withstand the introduction of metal pins, and at the place of their installation, rapid resorption of bone tissue will begin and pathological fractures may occur.Therefore, it is very important to make a timely decision about the need to install an endoprosthesis - it should be taken when the age and general condition of the human body still allow for the operation.According to the results of long-term studies, the duration of the effect of endoprosthetics, i.e. the temporary duration of the absence of significant motor limitations and maintaining a decent quality of life, is about ten years.The best results of surgical treatment are observed in people aged 45-75, who have a low body weight (less than 70 kg) and a relatively high standard of living.
Despite the widespread use of knee arthroplasty, the results of such operations are often unsatisfactory and the rate of complications is high.This is due to the design features of endoprostheses and the complexity of the surgical intervention itself (hip replacement is much simpler from a technical point of view).These include arthromedullary bypass surgery and corrective osteotomy.Arthromedullary shunting is the connection of the medullary canal of the femur with the cavity of the knee joint using a shunt - a hollow metal tube.Thanks to this, fatty bone marrow from the lower third of the thigh enters the knee joint, nourishes the cartilage and moisturizes it, thereby achieving a significant reduction in pain.
When the axis of the lower extremity changes (but in conditions of slight limitation of the range of motion), corrective osteotomy is effective - sectioning of the tibia by adjusting its axis, followed by fixation with a plate and screws in the desired position.In this case, two goals are achieved - the normalization of biomechanics due to the restoration of the axis of the limb, as well as the activation of blood circulation and metabolism during bone fusion.And although today's medicine cannot offer a drug that will get rid of it forever, or other ways to completely cure this disease, a healthy lifestyle, timely seeking medical help and following the doctor's recommendations can stop its progression.